Pearlstein Teri, Yonkers Kimberly A, Fayyad Rana, Gillespie John A
Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA.
J Affect Disord. 2005 Apr;85(3):275-82. doi: 10.1016/j.jad.2004.10.004.
Use of intermittent dosing strategies for the treatment of premenstrual dysphoric disorder (PMDD) highlights the need for detailed empirical data on the onset, duration and pattern of symptom expression in women suffering from PMDD.
Data were analyzed from 276 women who met DSM-IV criteria for PMDD and prospectively charted two menstrual cycles prior to commencing sertraline treatment. The presence and severity of PMDD symptoms were measured using the Daily Record of Severity of Problems (DRSP).
The most frequent PMDD symptoms (moderate-to-severe for > or = 3 days) included anger/irritability (76%), anxiety/tension (71%), tired/lethargic (58%), and mood swings (58%). Mean DRSP scores peaked at day -2 (2 days prior to the onset of menses), but the within-patient day of onset of PMDD-level symptoms was highly variable, differing from cycle-to-cycle by > or = 4 days in 45% of women. Similarly, the within-patient duration of PMDD symptoms varied from cycle-to-cycle by 3 or more days in > or = 50% of women. Depending on the criteria used, 1 day after the onset of menstruation, 34-46% of women continued to report moderate to severe symptoms.
Women in this sample were recruited for participation in a treatment study, and the results may not generalize to women with PMDD in the community.
The results of this analysis found significant within-patient variability in the time-to-onset and offset of PMDD symptoms, as well as their duration. The temporal pattern and high degree of within-patient variability across menstrual cycles of PMDD symptoms may have treatment implications.
采用间歇性给药策略治疗经前烦躁障碍（PMDD）凸显了获取PMDD女性症状发作、持续时间及症状表现模式详细实证数据的必要性。
对符合PMDD的《精神疾病诊断与统计手册》第四版（DSM-IV）标准的276名女性的数据进行分析，并在开始舍曲林治疗前前瞻性记录两个月经周期。使用问题严重程度每日记录（DRSP）来测量PMDD症状的存在情况和严重程度。
最常见的PMDD症状（中度至重度，持续≥3天）包括愤怒/易怒（76%）、焦虑/紧张（71%）、疲倦/无精打采（58%）和情绪波动（58%）。DRSP平均得分在第-2天（月经开始前2天）达到峰值，但PMDD水平症状在患者个体内的发作日期高度可变，45%的女性不同周期之间相差≥4天。同样，≥50%的女性PMDD症状在患者个体内的持续时间在不同周期之间相差3天或更多天。根据所使用的标准，月经开始后1天，34 - 46%的女性仍报告有中度至重度症状。
本样本中的女性是为参与一项治疗研究而招募的，结果可能不适用于社区中的PMDD女性。
该分析结果发现，PMDD症状的发作时间、缓解时间及其持续时间在患者个体内存在显著差异。PMDD症状在月经周期中的时间模式和患者个体内的高度变异性可能对治疗有影响。
